Treatment Name: Alectinib (Alecensa®)
How does alectinib work?
Alectinib is designed to bind to and block the function of a mutated protein called “anaplastic lymphoma kinase” (ALK) present in cancer cells. The mutated ALK protein causes the cancer cell to grow and divide more rapidly and to survive longer. Approximately 2% to 7% of patients with NSCLC have this mutation. By blocking the function of the abnormally active ALK protein, alectinib slows the growth of the cancer and causes some of the cancer cells to die.
Goals of therapy:
Alectinib is given to patients to slow the progression and to stop the spreading of lung cancer and is not currently given with the goal of cure.
- Usual starting dose: 600 mg (four 150 mg capsules) by mouth twice daily with food
Alectinib is usually taken at home and is continued until it no longer works or until unacceptable side effects occur.
In clinical studies, the most commonly reported alectinib (Alecensa®) side effects of are shown here. Side effects sometimes have percentage ranges [example: 33 – 36%] because they differed between clinical studies:
A note about side effect percentages
- Constipation (33-36%)
- Fatigue (26-33%)
- Swelling in arms and legs (17-25%)
- Muscle pain (16-24%)
- Nausea (11-22%)
- Headache (16-21%)
- Diarrhea (9-21%)
- Laboratory signs of liver injury (8-21%)
- Low red blood cells [Anemia] (18-20%)
- Weakness (18%)
- Shortness of breath (13-18%)
- Cough (14-17%)
- Weight gain (10-16%)
- Skin rash (12%)
- Mouth sores (12%)
- Trouble sleeping (12%)
- Vomiting (6-12%)
- Sinus infection (10%)
- Back pain (10%)
- Dizziness (8-10%)
- Sensitivity to sunlight (5-10%)
- Pain in muscles, joints, and bones (7%)
- Low white blood cells [neutropenia] (3-4%)
- Seizures (3%)
- Change in taste buds (3%)
- Stomach pain (2%)
- Blurry vision (2%)
- Change in vision (1%)
- Hair loss (1%)
On average, 2-11% of patients discontinue alectinib treatment due to unacceptable side effects.
Importantly, not all people who experience a side effect from Alcensa® (alectinib) will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid future treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with Alcensa®, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, then every two weeks for the first 3 months of therapy, then monthly thereafter. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), CPK, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment then approximately every 6 to 9 weeks during treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue alectinib as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Alectinib may cause an increased sensitivity to sunlight. Avoid long periods of sun exposure while taking alectinib and for at least 7 days after stopping therapy. When outside, wear proper clothing to cover your skin from the sun. Use a broad spectrum sunscreen (SPF ≥ 50) to help protect against potential sunburn
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for non-small cell lung cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Alectinib (Alecensa®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Alectinib (Alecensa®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Alectinib (Alecensa®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Alectinib (Alecensa®)
1) Hida T, Nokihara H, Kondo M, et al. Alectinib versus crizotinib in patients with ALK-positive non-small-cell lung cancer (J-ALEX): an open-label, randomised phase 3 trial. Lancet. 2017;390:29-39.
2) Ou SH, Ahn JS, De Petris L, et al. Alectinib in Crizotinib-Refractory ALK-Rearranged Non-Small-Cell Lung Cancer: A Phase II Global Study. J Clin Oncol 2016;34:661-668.
3) Shaw AT, Gandhi L, Gadgeel S, at al. Alectinib in ALK-positive, crizotinib-resistant, non-small-cell lung cancer: a single-group, multicentre, phase 2 trial. Lancet Oncol. 2016;17:234-242.
4) Peters S, Camidge DR, Shaw AT, et al. Alectinib versus Crizotinib in Untreated ALK-Positive Non-Small-Cell Lung Cancer. N Engl J Med. 2017;377:829-838.